CHAPTER 20:43:09

ANESTHESIA AND ANALGESIA

Section

20:43:09:01        Definitions.

20:43:09:02        Prohibitions.

20:43:09:03        General anesthesia and deep sedation permit requirements.

20:43:09:04        Moderate sedation permit requirements.

20:43:09:04.01    Employing or contracting with licensed anesthesia provider that provides general anesthesia, deep sedation, or moderate sedation in dental office.

20:43:09:04.02    Utilizing licensed anesthesia provider for general anesthesia and deep sedation or moderate sedation in ambulatory surgery center or hospital.

20:43:09:04.03    Moderate sedation course requirements.

20:43:09:04.04    Host permit requirements.

20:43:09:04.05    Host course requirements.

20:43:09:04.06    Anesthesia or sedation education -- Other.

20:43:09:05        Nitrous oxide sedation and analgesia permit requirements -- Dentists.

20:43:09:06        Nitrous oxide sedation and analgesia permit requirements and authorization -- Dental hygienists and registered dental assistants.

20:43:09:06.01    Local anesthesia permit requirements and authorization -- Dental hygienists.

20:43:09:06.02    Minimal sedation.

20:43:09:07        Noncompliance.

20:43:09:08        Permits -- Application fees -- Temporary permits -- Renewal.

20:43:09:09        Reports of adverse conditions.

20:43:09:10        Permit requirements to monitor patients under general anesthesia, deep sedation, or moderate sedation.

20:43:09:10.01    Delegation of injection of medication.

20:43:09:10.02    Injecting medication.

20:43:09:11        Inspection.

20:43:09:12        Requirements of inspection.

20:43:09:13        Equipment -- Moderate sedation.

20:43:09:13.01    Equipment -- General anesthesia and deep sedation.

20:43:09:14        Clinical guidelines.

20:43:09:15        Intravenous line.

20:43:09:16        Anesthesia credentials committee.

20:43:09:17        Emergency response protocol.

    20:43:09:01.  Definitions. As used in this chapter:

    (1)  "Accredited" means a program accredited by the American Dental Association Commission on Dental Accreditation;

    (2)  "Deep sedation" means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained;

    (3)  "General anesthesia" means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired;

    (4)  "Incremental dosing" means administration of multiple doses of a drug until a desired effect is reached but not to exceed the maximum recommended dose;

    (5)  "Maximum recommended dose" means the maximum U.S. Food and Drug Administration recommended dose of a drug, as printed in U.S. Food and Drug Administration approved labeling for unmonitored home use;

    (6)  "Minimal sedation" means a minimally depressed level of consciousness, produced by apharmacological method, that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected;

    (7)  "Moderate sedation" means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Reflex withdrawal from a painful stimulus is not considered a purposeful response. No interventions are required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained; and

    (8)  "Nitrous oxide sedation and analgesia" means the administration, by inhalation, of a combination of nitrous oxide and oxygen producing a minimally depressed level of consciousness that retains the patient's ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command.

    Source: 9 SDR 49, effective October 25, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; transferred from §§ 20:43:04:08 and 20:43:04:10, 19 SDR 32, effective September 6, 1992; 37 SDR 131, effective January 6, 2011; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(13)(14)(22).

    20:43:09:02.  Prohibitions. A dentist licensed in this state may not administer general anesthesia and deep sedation, moderate sedation, or nitrous oxide sedation and analgesia unless the dentist has obtained the permit required in § 20:43:09:03, 20:43:09:04, or 20:43:09:05.

    Any dentist who advertises sedation using terms other than minimal sedation or nitrous oxide sedation and analgesic must have a general anesthesia and deep sedation, moderate sedation, or host permit.

    Source: 19 SDR 32, effective September 6, 1992; 37 SDR 131, effective January 6, 2011; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(13)(14)(22).

    20:43:09:03.  General anesthesia and deep sedation permit requirements. The board may issue a permit to a licensed dentist to administer general anesthesia and deep sedation to dental patients on an outpatient basis if the dentist:

    (1)  Has successfully completed an accredited advanced dental education residency program in oral and maxillofacial surgery or dental anesthesiology that provides comprehensive and appropriate training necessary to administer general anesthesia or deep sedation. If the residency was completed more than 12 months before application for a permit, the applicant shall also:

            (A)  Hold a permit to administer general anesthesia and deep sedation, or an equivalent permit, in another state and have completed a minimum of 50 general anesthesia or deep sedation cases in the 12 months before application; or

            (B)  Undergo a review by the board of the applicant’s recent training and experience and complete supplemental training, education, evaluation, or remediation required by the board. The applicant shall pay all costs of the training, education, evaluation, remediation, and proceedings;

    (2)  Has met the requirements outlined in §§ 20:43:09:12 and 20:43:09:13.01; and

    (3)  Is certified in administering Advanced Cardiovascular Life Support by the American Heart Association or an equivalent program approved by the board, and, if providing general anesthesia or deep sedation to a patient under 12 years, is certified in Pediatric Advanced Life Support by the American Heart Association or an equivalent program approved by the board.

    A dentist with a general anesthesia and deep sedation permit may not administer general anesthesia or deep sedation without the presence and assistance of at least two individuals who hold a permit to monitor patients under general anesthesia, deep sedation, or moderate sedation, or are otherwise authorized by law to monitor patients under general anesthesia, deep sedation, or moderate sedation.

    A dentist administering general anesthesia or deep sedation shall be proficient in airway management and advanced cardiac life support; shall be capable of providing intravenous access; shall continuously evaluate the patient’s blood pressure, pulse, respiratory function and cardiac activity; and shall apply the current standard of care.

    A general anesthesia and deep sedation permit incorporates the authority granted by a moderate sedation permit, a nitrous oxide sedation and analgesia permit, and a host permit.

    Source: 9 SDR 49, effective October 25, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; transferred from § 20:43:04:08, 19 SDR 32, effective September 6, 1992; 26 SDR 37, effective September 20, 1999; 37 SDR 131, effective January 6, 2011; 42 SDR 83, effective December 3, 2015; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(3)(13)(14)(22).

    20:43:09:04.  Moderate sedation permit requirements. The board may issue a permit to a licensed dentist to administer moderate sedation to dental patients 12 years and older on an outpatient basis if the dentist:

    (1)  Has successfully completed a moderate sedation course approved by the board pursuant to § 20:43:09:04.03. If the course was completed more than 12 months before application, the applicant shall also:

            (A)  Hold a permit to administer moderate sedation, or an equivalent permit, in another state and have completed a minimum of 12 moderate sedation cases in the 12 months before application; or

            (B)  Undergo a review by the board of the applicant’s recent training and experience and complete supplemental training, education, evaluation, or remediation required by the board. The applicant shall pay all costs of the training, education, evaluation, remediation, and associated proceedings;

    (2)  Has met the requirements outlined in §§ 20:43:09:12 and 20:43:09:13; and

    (3)  Is certified in administering Advanced Cardiovascular Life Support by the American Heart Association or an equivalent program approved by the board.

    A dentist with a moderate sedation permit may not administer moderate sedation without the presence and assistance of at least one individual who holds a permit to monitor patients under general anesthesia, deep sedation, or moderate sedation, or is otherwise authorized by law to monitor patients under general anesthesia, deep sedation, or moderate sedation.

    A dentist administering moderate sedation may not use general anesthetics; shall be proficient in airway management and advanced cardiac life support; shall be capable of providing intravenous access; shall continuously evaluate the patient’s blood pressure, pulse, respiratory function, and cardiac activity; and shall apply the current standard of care.

    A dentist that meets the requirements of this section may only be authorized by the board to administer moderate sedation to a child under 12 years if the dentist has successfully completed an accredited advanced dental education residency program that provides comprehensive and appropriate training necessary to administer and manage pediatric moderate sedation and is certified in Pediatric Advanced Life Support by the American Heart Association or an equivalent program approved by the board. A dentist that does not meet these requirements by June 30, 2022, may not administer moderate sedation to a child under 12 years.

    A dentist who administers moderate sedation shall maintain a margin of safety and a level of consciousness in the patient that does not approach general anesthesia or deep sedation and shall be able to rescue a patient whose level of sedation becomes deeper than initially intended.

    If moderate sedation results in a general anesthetic state, the requirements outlined in § 20:43:09:03 for general anesthesia and deep sedation apply.

    A moderate permit incorporates the authority granted in a nitrous oxide sedation and analgesia permit and host permit. A dentist that holds a moderate sedation permit and utilizes a licensed anesthesia provider to administer general anesthesia, deep sedation, or moderate sedation to a patient under 12 years shall also be certified in Pediatric Advanced Life Support by the American Heart Association or an equivalent program approved by the board.

    Source: 9 SDR 49, effective October 25, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; transferred from § 20:43:04:11, 19 SDR 32, effective September 6, 1992; 37 SDR 131, effective January 6, 2011; 42 SDR 83, effective December 3, 2015; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(3)(13)(14)(22).

    20:43:09:04.01.  Employing or contracting with licensed anesthesia provider that provides general anesthesia, deep sedation, or moderate sedation in dental office. A dentist that holds a general anesthesia and deep sedation, moderate sedation, or host permit and utilizes a licensed anesthesia provider to administer general anesthesia, deep sedation, or moderate sedation in a dental office or facility on an outpatient basis to a dental patient on whom the dentist is performing a dental procedure shall:

    (1)  Have a written contract or written agreement with the licensed anesthesia provider that outlines the appropriate roles and responsibilities of the dentist, licensed anesthesia provider, and clinical staff, for the administration of sedation or anesthesia, that shall include requirements that the licensed anesthesia provider:

            (A)  Collaborate with the dentist on patient selection based on clearly defined patient selection criteria;

            (B)  Be continuously present during the administration of the anesthetic;

            (C)  Remain with the patient until the patient is communicating effectively;

            (D)  Transfer care of the patient to an individual who holds a permit to monitor patients under general anesthesia, deep sedation, or moderate sedation, or is otherwise authorized by law to monitor patients under general anesthesia, deep sedation, or moderate sedation; and

            (E)  Remain on the premises of the facility where the anesthesia was administered until the anesthetized patient is fully recovered and discharged from the facility to a responsible adult;

    (2)  Notify the board of the location of any dental office or facility where general anesthesia, deep sedation, or moderate sedation services will be provided;

    (3)  Ensure the availability of auxiliary personnel that are certified in administering basic life support by the American Heart Association for the Healthcare Provider, the American Red Cross for the Professional Rescuer, or an equivalent program approved by the board;

    (4)  Verify that the requirements for the level of anesthesia or sedation being provided, as required in § 20:43:09:13 or 20:43:09:13.01, are satisfied;

    (5)  Hold a general anesthesia and deep sedation, moderate sedation, or host permit and have completed the inspection, as required in § 20:43:09:12;

    (6)  Ensure that the licensed anesthesia provider holds a license in good standing in South Dakota;

    (7)  Ensure that the licensed anesthesia provider's qualifications and competency to deliver the necessary sedation or anesthesia services have been meaningfully verified; and

    (8)  Ensure that the licensed anesthesia provider is not administering general anesthesia and deep sedation without the presence and assistance of at least one individual, other than the dentist completing the dental procedure, who holds a permit to monitor patients under general anesthesia, deep sedation, or moderate sedation, or is otherwise authorized by law to monitor patients under general anesthesia and deep sedation.

    Source: 37 SDR 131, effective January 6, 2011; 42 SDR 83, effective December 3, 2015; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(13)(14)(22).

    20:43:09:04.02.  Utilizing licensed anesthesia provider for general anesthesia and deep sedation or moderate sedation in ambulatory surgery center or hospital. No permit is required if a dentist utilizes the services of a licensed anesthesia provider for dental patients in a licensed ambulatory surgery center or hospital.

    Source: 37 SDR 131, effective January 6, 2011; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(13)(22).

    20:43:09:04.03.  Moderate sedation course requirements. The board may approve a moderate sedation training course as referenced in subdivision 20:43:09:04(1) if the course meets the following requirements:

    (1)  The course satisfies all objectives and content as described in Part 5 of the Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students;

    (2)  The course includes a minimum of 60 clock hours of coursework that is provided through didactic instruction;

    (3)  The course includes the administration of moderate parenteral sedation via the intravenous route to at least 20 individually managed live patients of the appropriate age. The course participant must be listed on the anesthesia record, administer the drugs, and document the administration and physiologic findings on the anesthesia record;

    (4)  The course includes clinical experience in the management of the compromised airway and establishment of intravenous access;

    (5)  The course is directed by a dentist or physician qualified by experience and training, including the following:

            (A)  The course director has not been disciplined for conduct that, in the opinion of the board, would jeopardize the safety of the public or patients;

            (B)  The course director holds a current permit or license to administer general anesthesia and deep sedation or moderate sedation in at least one state; and

            (C)  The course director has at least three years of experience administering general anesthesia and deep sedation or moderate sedation, including formal postdoctoral residency training in anxiety and pain control;

    (6)  The course has a clinical participant-faculty ratio of not more than four-to-one;

    (7)  The course includes a mechanism for the course participant to evaluate the performance of individuals presenting the course material, a summary of which is maintained and available for review;

    (8)  The course provides additional clinical experience if the course participant has not achieved competency within the time allotted for the course; and

    (9)  The course director certifies the competency of a course participant in each moderate sedation technique, including instruction, clinical experience, managing the airway, intravascular or intraosseous access, and reversal drugs, before the course participant is issued documentation verifying successful completion of the course.

    The board shall conduct a review of moderate sedation courses annually and may only approve courses that have submitted documentation necessary to verify that the course requirements outlined in this section have been met. A course director may be required to participate in an interview as part of the course review before the board approves the course.

    Source: 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(3)(13)(22).

    References: "Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students," 2016 Edition, American Dental Association. Copies may be obtained from the American Dental Association at www.ada.org free of charge.

    20:43:09:04.04.  Host permit requirements. The board may issue a permit to a licensed dentist to utilize a licensed anesthesia provider to administer general anesthesia, deep sedation, or moderate sedation, in compliance with § 20:43:09:04.01 on an outpatient basis to a dental patient on whom the dentist is performing a dental procedure, if the dentist:

    (1)  Has successfully completed a course approved by the board that meets the criteria outlined in § 20:43:09:04.05. If the course was completed more than 12 months before application for a permit, the applicant must also hold a permit equivalent to the host permit in another state;

    (2)  Has met the requirements outlined in § 20:43:09:12;

    (3)  Has met the requirements outlined in § 20:43:09:13 or 20:43:09:13.01, based on the highest level of sedation or anesthesia that will be provided to a patient; and

    (4)  Is certified in administering Advanced Cardiovascular Life Support by the American Heart Association or an equivalent program approved by the board.

    A dentist that holds a host permit is authorized to monitor a patient under general anesthesia, deep sedation, or moderate sedation. A dentist that holds a host permit and utilizes a licensed anesthesia provider to provide general anesthesia, deep sedation, or moderate sedation to a patient under 12 years shall also be certified in Pediatric Advanced Life Support by the American Heart Association or an equivalent program approved by the board.

    Source: 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(13)(14)(22).

    20:43:09:04.05.  Host course requirements. The board may approve an educational course as referenced in subdivision 20:43:09:04.04(1) if the course meets the following requirements:

    (1)  The course provides instruction and an assessment of knowledge and skill in the following areas:

            (A)  Preoperative patient assessment;

            (B)  Emergency scenarios and rescue;

            (C)  Respiratory complications;

            (D)  Patient safety and monitoring;

            (E)  Airway assessment and management;

            (F)  Anesthetic drugs; and

            (G)  Recovery; and

    (2)  Upon completion, the course participant can:

            (A)  Identify a high-risk patient;

            (B)  Differentiate between levels of sedation;

            (C)  Monitor a patient receiving sedation or anesthesia; and

            (D)  Rescue a patient from a deeper-than-intended level of sedation.

    The board shall conduct a review of courses annually and may only approve courses that have submitted documentation necessary to verify that the course requirements outlined in this section have been met. A course director may be required to participate in an interview as part of the course review before the board approves the course.

    Source: 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(3)(13)(22).

    20:43:09:04.06.  Anesthesia or sedation education -- Other. At its discretion, in lieu of the requirement outlined in subdivision 20:43:09:03(1), 20:43:09:04(1), or 20:43:09:04.04(1), the board may consider training or experience accepted in any state or jurisdiction that resulted in an equivalent permit being issued to or maintained by the applicant. The board may deem such training or experience substantially equivalent and issue a permit or may require that the applicant complete supplemental training, education, evaluation, or remediation before a permit may be issued. The applicant shall pay all costs of the training, education, evaluation, remediation, or proceedings.

    Source: 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(13)(22).

    20:43:09:05.  Nitrous oxide sedation and analgesia permit requirements -- Dentists. The board may issue a permit to a dentist to administer nitrous oxide sedation and analgesia to dental patients on an outpatient basis if the dentist:

    (1)  Is certified in administering basic life support by the American Heart Association for the Healthcare Provider, the American Red Cross for the Professional Rescuer, or an equivalent program approved by the board; and

    (2)  Has successfully completed a board-approved course that meets the objectives and content as described in Part 4 of the Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students or a course in nitrous oxide sedation and analgesia through an accredited dental school and either:

            (A)  Completed the course within 13 months before application for a permit; or

            (B)  Completed the course more than 13 months before application, has legally administered nitrous oxide sedation and analgesia for a period of time during the three years preceding application, and attests to the applicant's current clinical proficiency to administer nitrous oxide sedation and analgesia.

    A dentist that administers nitrous oxide sedation and analgesia must use equipment with fail-safe features, a 30-percent-minimum oxygen flow, and a scavenger system.

    If a patient is 12 years or older, a dentist may administer nitrous oxide sedation and analgesia in combination with a single enteral drug to achieve minimal sedation only if the maximum recommended dose of the enteral drug is not exceeded. Incremental dosing may be utilized. A dentist may not administer nitrous oxide sedation and analgesia in combination with more than one enteral drug or by dosing a single enteral drug in excess of the maximum recommended dose unless the dentist holds the appropriate general anesthesia and deep sedation permit or moderate sedation permit.

    Source: 9 SDR 49, effective October 25, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; transferred from § 20:43:04:12, 19 SDR 32, effective September 6, 1992; 37 SDR 131, effective January 6, 2011; 42 SDR 83, effective December 3, 2015; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(3)(13)(14)(22).

    Reference: "Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students," 2016 Edition, American Dental Association. Copies may be obtained from the American Dental Association at www.ada.org free of charge.

    20:43:09:06.  Nitrous oxide sedation and analgesia permit requirements and authorization -- Dental hygienists and registered dental assistants. The State Board of Dentistry may issue a permit to a dental hygienist or a registered dental assistant to administer nitrous oxide sedation and analgesia to dental patients on an outpatient basis under the supervision of a dentist if the dental hygienist or registered dental assistant:

    (1)  Is certified in administering basic life support by the American Heart Association for the Healthcare Provider, the American Red Cross for the Professional Rescuer, or an equivalent program approved by the State Board of Dentistry; and

    (2)  Has successfully completed a State Board of Dentistry-approved educational course that substantially meets the objectives and content as described in Part 4 of the Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students and either:

        (a)  Completed the course within thirteen months prior to application for a permit; or

        (b)  Completed the course more than thirteen months prior to application for a permit, has legally administered nitrous oxide sedation and analgesia for a period of time during the three years preceding application, and provides written documentation from a dentist who has employed or supervised the applicant, attesting to the current clinical proficiency of the applicant to administer nitrous oxide sedation and analgesia.

    A dental hygienist or registered dental assistant who administers nitrous oxide sedation and analgesia shall use equipment with fail-safe features, a thirty-percent-minimum oxygen flow, and a scavenger system.

    A dental hygienist or registered dental assistant with a permit to administer nitrous oxide sedation and analgesia may administer nitrous oxide sedation and analgesia to dental patients under the dentist’s indirect supervision, as that term is defined in SDCL 36-6A-1.

    A dental hygienist with a permit to administer nitrous oxide sedation and analgesia may administer nitrous oxide sedation and analgesia to dental patients eighteen years and older under the dentist’s general supervision, as that term is defined in SDCL 36-6A-1, if the supervising dentist has authorized the administration and the authorization is included in the patient's record. If there has been a relevant change in the patient's medical history since the authorization, the dental hygienist must consult with the dentist before administering nitrous oxide sedation and analgesia. The dentist shall ensure a written emergency response protocol is in place for patients receiving nitrous oxide sedation and analgesia by the dental hygienist under general supervision.

    Source: 19 SDR 32, effective September 6, 1992; 32 SDR 188, effective May 15, 2006; 37 SDR 131, effective January 6, 2011; 42 SDR 19, effective August 17, 2015; 42 SDR 83, effective December 3, 2015; 48 SDR 62, effective December 13, 2021; 50 SDR 12, effective August 8, 2023.

    General Authority: SDCL 36-6A-14(10)(20).

    Law Implemented: SDCL 36-6A-14(1)(3)(7)(10)(13)(14)(22), 36-6A-40.

    Reference: "Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students," 2016 Edition, American Dental Association. Copies may be obtained from the American Dental Association at www.ada.org free of charge.

    20:43:09:06.01.  Local anesthesia permit requirements and authorization -- Dental hygienists. The State Board of Dentistry may issue a permit to a dental hygienist to administer local anesthesia to dental patients on an outpatient basis under the supervision of a dentist if the dental hygienist has met the following requirements:

    (1)  Is certified in administering basic life support by the American Heart Association for the Healthcare Provider, the American Red Cross for the Professional Rescuer, or an equivalent program approved by the State Board of Dentistry; and

    (2)  Has successfully completed a State Board of Dentistry-approved educational course on local anesthesia from an accredited dental or dental hygiene school and either:

        (a)  Completed the course within thirteen months prior to application for a permit; or

        (b)  Completed the course more than thirteen months prior to application for a permit, has legally administered local anesthesia for a period of time during the three years preceding application, and provides written documentation from a dentist that has employed or supervised the applicant, attesting to the current clinical proficiency of the applicant to administer local anesthesia.

    A dental hygienist with a permit to administer local anesthesia may administer local anesthesia to dental patients under the dentist’s indirect supervision, as that term is defined in SDCL 36-6A-1.

    A dental hygienist with a permit to administer local anesthesia may administer local anesthesia to dental patients eighteen years and older under the dentist’s general supervision, as that term is defined in SDCL 36-6A-1, if the supervising dentist has authorized the administration and the authorization is included in the patient's record. If there has been a relevant change in the patient's medical history since the authorization, the dental hygienist must consult with the dentist before administering local anesthesia. The dentist shall ensure a written emergency response protocol is in place for patients receiving local anesthesia by the dental hygienist under general supervision.

    Source: 37 SDR 131, effective January 6, 2011; 42 SDR 83, effective December 3, 2015; 50 SDR 12, effective August 8, 2023.

    General Authority: SDCL 36-6A-14(10)(20).

    Law Implemented: SDCL 36-6A-14(1)(3)(7)(10)(13)(14)(22), 36-6A-40.

    20:43:09:06.02.  Minimal sedation. If a patient is 12 years or older, a dentist may administer an oral drug to achieve a state of minimal sedation without a permit. A dentist administering minimal sedation must have appropriate access to oxygen and suction and emergency drugs and must meet the standards of the Guidelines for the Use of Sedation and General Anesthesia by Dentists. If a patient is 12 years or older, a dentist may administer to the patient or prescribe for patient self-administration up to the maximum recommended dose of a single enteral drug per visit, to achieve a state of minimal sedation without a general anesthesia and deep sedation permit or moderate sedation permit.

    Source: 37 SDR 131, effective January 6, 2011; 42 SDR 83, effective December 3, 2015; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(3)(13)(14)(22).

    Reference: "Guidelines for the Use of Sedation and General Anesthesia by Dentists," 2016 Edition, American Dental Association. Copies may be obtained from the American Dental Association at www.ada.org free of charge.

    20:43:09:08.  Permits -- Application fees -- Temporary permits -- Renewal. The application fee for a general anesthesia and deep sedation, moderate sedation, or host permit is fifty dollars. The application fee for a permit for a dentist, dental hygienist, or registered dental assistant to administer nitrous oxide sedation and analgesia is forty-five dollars. The application fee for a permit for a dental hygienist to administer local anesthesia is forty-five dollars.

    The State Board of Dentistry may issue a temporary permit to an applicant who has met the applicable requirements of this chapter. The board shall determine the duration of the temporary permit, which may not exceed one year. The temporary permit of a permit holder who fails an inspection is automatically suspended. Upon suspension, the applicant may request another inspection.

    A general anesthesia and deep sedation permit, moderate sedation permit, or host permit must be renewed annually. The renewal fee for a general anesthesia and deep sedation permit, a moderate sedation permit, or a host permit is fifty dollars. The board may conduct a re-evaluation of the credentials and facility of the permit holder for permit renewal. Any dentist renewing a general anesthesia and deep sedation permit or moderate sedation permit must be able to demonstrate continued competency as required by the board. A dentist who holds a general anesthesia and deep sedation permit shall complete at least fifty cases of general anesthesia or deep sedation annually. A dentist who holds a moderate sedation permit shall complete at least twelve cases of moderate sedation annually. If a dentist is unable to complete the required number of annual sedation or anesthesia cases, the dentist must complete three hours of board-approved continuing education that pertain to the administration and management of the applicable level of sedation or anesthesia for each case not completed. This continuing education is in addition to other continuing education permit requirements. A dentist who holds a general anesthesia and deep sedation, moderate sedation, or host permit shall document completion of team training on emergency response protocols at least annually in the setting where the anesthesia or sedation is being provided. The permit holder must provide documentation of the requirements outlined in this section to the board upon request.

    A nitrous oxide sedation and analgesia permit, local anesthesia permit, and permit to monitor patients under general anesthesia, deep sedation, or moderate sedation must be renewed annually. The renewal fee for a nitrous oxide sedation and analgesia permit for a dentist is fifty dollars. The renewal fee for a nitrous oxide sedation and analgesia permit for a dental hygienist is thirty-five dollars. The renewal fee for a nitrous oxide sedation and analgesia permit for a registered dental assistant is thirty-five dollars. The renewal fee for a permit to administer local anesthesia for a dental hygienist is thirty-five dollars. There is no renewal fee for a permit to monitor patients under general anesthesia, deep sedation, or moderate sedation.

    Failure to properly renew a general anesthesia and deep sedation permit, moderate sedation permit, host permit, nitrous oxide sedation and analgesia permit, local anesthesia permit, or a permit to monitor patients under general anesthesia, deep sedation, or moderate sedation constitutes an automatic suspension of the permit.

    Source: 19 SDR 32, effective September 6, 1992; 37 SDR 131, effective January 6, 2011; 38 SDR 172, effective April 25, 2012; 42 SDR 19, effective August 17, 2015; 42 SDR 83, effective December 3, 2015; 48 SDR 62, effective December 13, 2021; 50 SDR 64, effective November 29, 2023.

    General Authority: SDCL 36-6A-14(20), 36-6A-50(12)

    Law Implemented: SDCL 36-6A-14(9)(14)(22), 36-6A-23(2), 36-6A-50(12).

    20:43:09:09.  Reports of adverse conditions. All dentists must notify the board within 72 hours after any death or any incident that results in temporary or permanent physical or mental injury requiring medical treatment of the dentist's patient during, or as a result of, the administration of general anesthesia and deep sedation, moderate sedation, or nitrous oxide sedation and analgesia. A complete written report of the incident must be submitted to the board within 30 days. The report shall be submitted on a form provided by the board.

    Failure to comply with reporting requirements constitutes an automatic suspension of the general anesthesia and deep sedation, moderate sedation, host, or nitrous oxide sedation and analgesia permit.

    Source: 19 SDR 32, effective September 6, 1992; 37 SDR 131, effective January 6, 2011; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(2)(14)(22).

    20:43:09:11.  Inspection. The dentist subject to an inspection shall be responsible for all costs associated with an inspection. The inspection shall be completed by one or more inspectors approved by the board.Inspectors shall be individuals who are legally authorized to administer anesthesia or sedation at the level of the inspection being completed; have at least three years of experience administering dental anesthesia or sedation in a dental office; have not been disciplined for conduct that, in the opinion of the board, would jeopardize the safety of the public or patients; and abide by the inspection process approved by the board.

    A dentist who applies for a general anesthesia and deep sedation, moderate sedation, or host permit shall pass a facility inspection conducted at the facility where anesthesia or sedation will be provided before a temporary general anesthesia and deep sedation, moderate sedation, or host permit may be issued.

    A dentist who holds a temporary general anesthesia and deep sedation, moderate sedation, or host permit shall pass a full inspection before a general anesthesia and deep sedation, moderate sedation, or host permit may be issued.

    A dentist who holds a general anesthesia and deep sedation, moderate sedation, or host permit shall pass a full inspection at least once in each five-year licensure cycle to maintain the permit.

    Failing an inspection constitutes an automatic suspension of the permit and may subject the dentist to disciplinary proceedings.

    Source: 9 SDR 49, effective October 25, 1982; 12 SDR 151, 12 SDR 155, effective July 1, 1986; transferred from § 20:43:04:09, 19 SDR 32, effective September 6, 1992; 37 SDR 131, effective January 6, 2011; 42 SDR 83, effective December 3, 2015; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(2)(13)(22).

    20:43:09:12.  Requirements of inspection. Each inspection must be completed for the dentist whose permit or application is under review using an inspection form and process approved by the board and must include the following:

    (1)  For a facility inspection to obtain a temporary general anesthesia and deep sedation, moderate sedation, or host permit, an evaluation of:

            (A)  The physical facility in which anesthesia or sedation will be provided;

            (B)  The drugs, emergency medications, staff, and equipment necessary for the safe administration of the level of anesthesia or sedation authorized by the permit; and

            (C)  The technical competency of the permit holder and clinical office staff to effectively respond to anesthesia-related emergencies;

    (2)  For a full inspection to obtain and maintain a host permit, an evaluation of:

            (A)  The physical facility in which anesthesia or sedation will be provided;

            (B)  The drugs, emergency medications, staff, and equipment necessary for the safe administration of the level of anesthesia or sedation authorized by the permit;

            (C)  The technical competency of the permit holder and clinical office staff to effectively respond to anesthesia-related emergencies; and

            (D)  Appropriate patient anesthesia records;

    (3)  For a full inspection to obtain and maintain a general anesthesia and deep sedation or moderate sedation permit, an evaluation of:

            (A)  The physical facility in which anesthesia or sedation will be provided;

            (B)  The drugs, emergency medications, staff, and equipment necessary for the safe administration of the level of anesthesia or sedation authorized by the permit;

            (C)  The technical competency of the permit holder and clinical office staff to effectively respond to anesthesia-related emergencies;

            (D)  Appropriate patient anesthesia records; and

            (E)  The technical competency of the permit holder to safely administer the level of anesthesia or sedation authorized by the permit.

    Source: 37 SDR 131, effective January 6, 2011; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(13)(14)(22).

    20:43:09:13.  Equipment -- Moderate sedation. Any dentist who administers moderate sedation or who provides dental services to patients under moderate sedation shall ensure that the office or facility in which the work is performed:

    (1)  Has an operatory of the appropriate size and design to permit access of emergency equipment and personnel and to permit appropriate emergency management;

    (2)  Has the following equipment:

        (A)  An automated external defibrillator or full function defibrillator that is immediately accessible;

        (B)  A positive pressure oxygen delivery system and a backup system;

        (C)  A functional suctioning device and a backup suction device;

        (D)  Auxiliary lighting;

        (E)  A gas storage facility;

        (F)  A recovery area. Recovery may take place in the surgical suite. If a separate recovery area is utilized, it must be of the appropriate size for emergency access and management and must have resuscitative equipment present;

        (G)  Methods to monitor respiratory and cardiac function, including all of the following:

            (1)   Pulse oximetry; and

            (2)  Electrocardiogram display;

            (3)  Precordial stethoscope;

            (4)  Measurement of EtCO2, capnography; and

            (5)  Blood pressure monitor; and

        (H)  Board approved and readily available emergency drugs and appropriately sized equipment necessary to resuscitate a non-breathing and unconscious patient and provide continuous support while the patient is transported to a medical facility. The permit holder shall provide documentation that all emergency drugs and equipment are inspected and maintained on a prudent and regularly scheduled basis, according to manufacturer specifications where applicable.

    Source: 37 SDR 131, effective January 6, 2011; 41 SDR 108, effective January 6, 2015; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(3)(13)(14)(22).

    20:43:09:13.01.  Equipment -- General anesthesia and deep sedation. Any dentist who administers general anesthesia or deep sedation or who provides dental services to patients under general anesthesia or deep sedation shall ensure that the office or facility in which the work is performed:

    (1)  Has an operatory of the appropriate size and design to permit access of emergency equipment and personnel and to permit appropriate emergency management;

    (2)  Has the following equipment:

        (A)  An automated external defibrillator or full function defibrillator that is immediately accessible;

        (B)  A positive pressure oxygen delivery system and a backup system;

        (C)  A functional suctioning device and a backup suction device;

        (D)  Auxiliary lighting;

        (E)  A gas storage facility;

        (F)  A recovery area. Recovery may take place in the surgical suite. If a separate recovery area is utilized, it must be of the appropriate size for emergency access and management and must have resuscitative equipment present;

        (G)  Methods to monitor respiratory and cardiac function, including all of the following:

            (1)  Pulse oximetry;

            (2)  Electrocardiogram display;

            (3)  Precordial or pretrachial stethoscope;

            (4)  Measurement of EtCO2, capnograpy; and

            (5)  Blood pressure monitor; and

    (H)  Board approved and readily available emergency drugs and appropriately sized equipment necessary to resuscitate a non-breathing and unconscious patient and provide continuous support while the patient is transported to a medical facility. The permit holder shall provide documentation that all emergency drugs and equipment are inspected and maintained on a prudent and regularly scheduled basis, according to manufacturer specifications where applicable.

    Source: 41 SDR 108, effective January 6, 2015; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(3)(13)(14)(22).

    20:43:09:14.  Clinical guidelines. A dentist who provides any level of sedation or utilizes the services of a licensed anesthesia provide shall apply the current standard of care.

    Source: 37 SDR 131, effective January 6, 2011; 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(3)(13)(14)(22).

    20:43:09:17.  Emergency response protocol. A dentist shall ensure a written emergency response protocol is in place for all patients undergoing moderate sedation, deep sedation, or general anesthesia.

    Source: 48 SDR 62, effective December 13, 2021.

    General Authority: SDCL 36-6A-14(20).

    Law Implemented: SDCL 36-6A-14(1)(13)(14)(22).